High Prevalence of Transjugular Intrahepatic Portosystemic Shunt Creation Without Prior Endoscopy During Acute Variceal Bleeding Hospitalization in the United States

Autor: Richard C. Lindrooth, P. Michael Ho, Matthew A. Brown, Premal S. Trivedi, Alexandria Jensen, Michael Kriss, Robert K. Ryu, Rustain Morgan
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Adult
Male
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Population
RC799-869
Logistic regression
Esophageal and Gastric Varices
Severity of Illness Index
Endoscopy
Gastrointestinal

Liver disease
Young Adult
medicine
Prevalence
Humans
Practice Patterns
Physicians'

education
Aged
Aged
80 and over

education.field_of_study
Hepatology
medicine.diagnostic_test
business.industry
General surgery
Odds ratio
Original Articles
Middle Aged
Diseases of the digestive system. Gastroenterology
medicine.disease
Confidence interval
United States
Endoscopy
Hospitalization
Cross-Sectional Studies
Logistic Models
Treatment Outcome
Acute Disease
Observational study
Female
Original Article
Portasystemic Shunt
Transjugular Intrahepatic

business
Gastrointestinal Hemorrhage
Transjugular intrahepatic portosystemic shunt
Zdroj: Hepatology Communications, Vol 5, Iss 10, Pp 1784-1790 (2021)
Hepatology Communications
Popis: Current clinical guidelines by both American Association for the Study of Liver Disease and European Association for the Study of the Liver recommend endoscopy in all patients admitted with acute variceal bleeding within 12 hours of admission. Transjugular intrahepatic portosystemic shunt (TIPS) creation may be considered in patients at high risk if hemorrhage cannot be controlled endoscopically. We conducted a cross‐sectional observational study to assess how frequently TIPS is created for acute variceal bleeding in the United States without preceding endoscopy. Adult patients undergoing TIPS creation for acute variceal bleeding in the United States (n = 6,297) were identified in the last 10 available years (2007‐2016) of the National Inpatient Sample. Hierarchical logistic regression was used to examine the relationship between endoscopy nonutilization and hospital characteristics, controlling for patient demographics, income level, insurance type, and disease severity. Of 6,297 discharges following TIPS creation for acute variceal bleeding in the United States, 31% (n = 1,924) did not receive first‐line endoscopy during the same encounter. Rates of “no endoscopy” decreased with increasing population density of the hospital county (nonmicropolitan counties 43%, n = 114; mid‐size metropolitan county 35%, n = 513; and central county with >1 million population 23%, n = 527) but not by hospital teaching status (n = 1,465, 32% teaching vs. n = 430, 26% nonteaching; P = 0.10). Higher disease mortality risk (odds ratio, 0.42; 95% confidence interval, 0.22‐0.80; P = 0.02) was associated with lower odds of noncompliance. Conclusion: One third of all patients undergoing TIPS creation for acute variceal bleeding in the United States do not receive first‐line endoscopy during the same encounter. Patients admitted to urban hospitals are more likely to receive guideline‐concordant care.
In this cross‐sectional, population‐based study we examined how often TIPS was created among patients for acute variceal bleeding without use of first‐line endoscopy as recommended by both American Association for the Study of Liver Disease (AASLD) and The European Association for the Study of the Liver (EASL) guidelines. We report endoscopy non‐utilization in nearly a third (n = 1924/6297, 31%) of such encounters nationally. We also found that endoscopy non‐utilization was more prevalent among hospitals in less densely populated counties.
Databáze: OpenAIRE